Sonographic appearance of a giant appendicular mucocele

Mucocele of the appendix is a rare but well-known entity. Accurate preoperative diagnosis of this surgically curable entity is very important to prevent intraoperative rupture. With multimodality approach using ultrasound and CT, it has been possible to preoperatively diagnose mucocele of the appendix. We describe the ultrasound and CT findings of a giant appendicular mucocele that led us to the correct preoperative diagnosis.     

The onion skin sign: a specific sonographic marker of appendiceal mucocele.

OBJECTIVE: To evaluate the association of the onion skin sign as a sonographic marker for appendiceal mucocele. METHODS: The sonographic onion skin sign was considered specific for the preoperative diagnosis of appendiceal mucocele. Therefore, detection of this sign in a mass located in the right lower abdomen, unrelated to the female reproductive organs, indicated surgical intervention with a presumptive diagnosis of appendiceal mucocele. From 1998 through 2001, female patients who were found to have atypical cysts containing this sign underwent surgery. The cases were closely followed, and intraoperative findings and final histologic diagnoses were recorded. RESULTS: Appendiceal mucocele was the final diagnosis in all 7 patients in whom the onion skin sign was observed. One additional patient had an appendiceal mucocele with a sonographic picture of a clear tubular cystic structure. CONCLUSIONS: A sonographically layered cystic mass in the right lower quadrant of the abdomen in the presence of a normal ovary strongly suggests the diagnosis of appendiceal mucocele. Recognition of the sonographic onion skin sign in a cystic mass in the right lower quadrant may facilitate the accurate preoperative diagnosis of appendiceal mucocele.     

Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report

BACKGROUNDAppendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin. We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.CASE SUMMARYA 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally. He was admitted to our hospital for a routine checkup without any symptoms. Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding. The preoperative diagnosis was non-neoplastic appendiceal mucocele, and endoscopic treatment was performed. The endoscopic findings and pathological results supported our preoperative diagnosis. The endoscopic treatment of appendiceal mucocele was feasible and effective, which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo. CONCLUSIONEndoscopic therapy provides a new method for the treatment of appendiceal mucocele.     

Mucocele of the appendix: an important clinical rarity

Mucocele is an uncommon pathology of the vermiform appendix that can be confused with acute appendicitis. We present a case of an appendiceal mucocele associated with subacute, intermittent right lower quadrant discomfort. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.     

Headache Caused by a Sphenoid Mucocele but Presenting as an Ergotamine-Induced Headache

In a 65-year-old woman, symptomatic headache caused by a mucocele of the sphenoid sinus led to ergotamine abuse and subsequent ergotamine-induced headache. Since there were no neurological symptoms initially and the patient previously suffered from migraine, the mucocele was not recognized. Only after unsuccessful drug withdrawal therapy and an MRI, was the correct diagnosis made. Surgical removal of the mucocele led to complete relief of headache within 3 weeks. We conclude that ergotamine-induced headache can develop on the basis of symptomatic headache. In spite of the effectiveness of ergotamine tartrate, an MRI should be performed if focal neurological symptoms occur.     

Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele

Purpose

To evaluate whether the onion skin sign on ultrasonography (US) of the lower abdomen is specific for the diagnosis of an appendiceal mucocele.

Methods

Our study included 231 lesions from 229 patients in whom transabdominal US detected lesions in the lower abdomen and who had definitive pathological diagnoses in the small bowel, ileocecal valve, cecum, appendix, mesentery, adnexa uteri or pelvic cavity outside the major organs. Patients with metastatic tumors were excluded. We reviewed the reports and images from transabdominal US and checked for the presence of the onion skin sign. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were calculated.

Results

Five (2.2 %) of the 231 lesions showed the onion skin sign on US and all were diagnosed with an appendiceal mucocele. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were 63, 100, and 99 %, respectively.

Conclusions

The onion skin sign in the lower abdomen appears to be specific for the diagnosis of an appendiceal mucocele. In cases where the onion skin sign is obviously present in the lower abdomen on US, an appendiceal mucocele should be considered as the leading diagnosis.     

经鼻内镜囊肿造袋术治疗鼻窦黏液囊肿的临床研究

目的 探讨经鼻内镜囊肿造袋术治疗鼻窦黏液囊肿的临床疗效，并研究鼻窦黏液囊肿组织的超微结构及与病理特性之间的关系，为鼻寞黏液囊肿造袋术提供理论依据。方法 30例鼻窦黏液囊肿病人均行经鼻内镜囊肿造袋术，手术后标本作电镜超微结构检查。结果 术后随访6～12月无1例复发。30例均为黏液囊肿，除1例为立方状上皮外，其余内衬上皮为假复层纤毛柱状上皮。上皮纤毛发达，线粒体丰富，内质网、高尔基氏体发达，黏液性腺细胞和杯状细胞浆中有大量黏液分泌颗粒，基底膜下有大量淋巴细胞、中性粒细胞及少量嗜酸性粒细胞浸润。结论 经鼻内镜囊肿造袋术是治疗鼻窦黏液囊肿的有效术式，具有微创、面部无瘢痕等优点。鼻窦黏液囊肿内衬上皮与鼻腔大部分黏膜一样均为假复层纤毛柱状上皮，纤毛发达，术后纤毛功能可以恢复，其超微结构与病理特性密切相关。     

Giant mucocele of the appendix: clinical and imaging findings in 3 cases.

OBJECTIVE: Clinical and imaging (sonographic and computed tomographic [CT]) findings in 3 cases of giant mucocele of the appendix are described. METHODS: Clinical records of 3 cases of giant mucocele of the appendix were reviewed. All patients had a basal B-mode sonographic examination and a contrast-enhanced sonographic examination using a second-generation low-mechanical index contrast medium. In all cases, a dual-phase spiral CT examination was carried out. RESULTS: In 2 cases, the abdominal masses were discovered in asymptomatic patients; 1 patient had vague abdominal discomfort. A pathologic diagnosis of benign cystoadenoma was found at pathologic examination in all cases, and malignant pseudomyxoma peritonei was disclosed in 1 patient 1 year later. Common sonographic findings were as follows: (1) a huge abdominal mass with a maximum diameter ranging between 20 and 25 cm; (2) a thin hyperechoic border without either solid vegetations or signs of infiltration of surrounding tissues; (3) a complex internal echo structure with anechoic lacunae interspersed between curvilinear, wavy bands of echogenic material (the so-called sonographic onion skin sign); and (4) avascularity of the masses shown on contrast-enhanced sonography with a low-mechanical index medium. At CT, a well-circumscribed cysticlike mass of low attenuation was displayed in all cases. There was lack of enhancement during a dual-phase examination in 2 cases; in the other, a small peripheral area of faint enhancement was appreciated. Only in the latter case could CT reliably assess the origin of the mass. CONCLUSIONS: It is suggested that a combination of sonographic (namely the onion skin sign) and CT findings may aid in the correct preoperative diagnosis of giant mucocele of the appendix.     

Mucocele of the surgically isolated esophagus

A large esophageal mucocele causing chest pain developed in a 26-year-old woman who had undergone esophageal bypass surgery and gastric interposition because of involvement by scleroderma. Computed tomographic (CT) scans showed the mucocele as an elongated mediastinal mass which spontaneously reduced in size during conservative management. The clinical and radiological features of this unusual postsurgical complication are herein reviewed.     

Value of 10 MHz ultrasound in diagnosis and follow-up of retrobulbar mucocele

Immediately after a flight from Europe to the USA a 45-year old German woman noticed an unilateral protrusion of the eye with retrobulbar pressure, diplopia and blurred vision. Except for a nasal polypectomy 23 years ago the past medical history was unremarkable. The above mentioned symptoms disappeared spontaneously but reoccurred after a second flight to Turkey six months later. The ultrasound examination of the orbital cavity showed a large suprabulbar mucocele which displaced the eyeball downwards. An intracerebral expansion was excluded by NMR-tomography. The mucocele was removed surgically but reappeared when the patient had a cold. All symptoms disappeared within 2 weeks of taking antibiotics. Fluctuation of the air pressure in the aeroplane and below atmosphere pressure let the air in the sinuses expand. Via a connection between the nasal sinuses and the mucocele, the mucus is forcibly pressed into the mucocele, and the internal pressure rises. The clinical symptoms will therefore increase suddenly during a flight. The ultrasound examination is a reliable method for the differential diagnosis of retrobulbar tumor and should be used for follow-up examinations because of the simplicity and safety of the method.     

Infected calcified mucocele of the appendix with histologic features of mucinous cystadenoma

A case of calcified and infected mucocele of the appendix is reported. The appearance of the calcification, the presence of gas with an air fluid level on plain films, and the opacification of the lumen of the mucocele by opaque enema allowed the correct radiologic diagnosis to be made.     

Ultrasonographic findings in diseases of the appendix.

Ultrasonographic findings in patients with diseases of the appendix, including acute appendicitis, suspected appendiceal abscess, and palpable right-lower-quadrant abdominal mass, are described. An appendiceal abscess may manifest as a cystic mass, a mixed solid and cystic mass, or a hypoechoic solid mass. An appendiceal calculus within an abscess can be recognized as a hyperechoic structure with acoustic shadowing. On ultrasonography, acute appendicitis in female patients may mimic tubo-ovarian disease. Ultrasonographic features of isolated Crohn's disease of the appendix and mucocele of the appendix are also described.     

Single-incision laparoscopic partial cecectomy for appendiceal mucocele in a patient with porphyria photosensitivity

Erythropoietic protoporphyria (EPP) is a rare hereditary subtype of cutaneous porphyria characterized by photosensitivity. Increased exposure to light irradiation may precipitate acute liver failure, and surgical light-induced intestinal burns and perforations are known to occur. We report a case of EPP in a patient who underwent laparoscopic partial cecectomy for appendiceal mucocele. A 55-year-old man with EPP was presented for treatment of appendiceal mucocele. A light test using two types of laparoscopes (Companies O and S) was performed preoperatively. Light from the laparoscope manufactured by Company O caused photosensitivity; this effect was not observed with light from the laparoscope manufactured by Company S. Therefore, we performed laparoscopic partial cecectomy through a single umbilical incision using the laparoscope from Company S. Except for the incision site, the patient's skin was completely covered using surgical drapes. No intra- or postoperative complications were observed. Histopathological examination of the resected specimen revealed a low-grade appendiceal mucinous neoplasm.     

经直肠腔内超声在肛肠病变诊断上的应用

目的：探讨肛管直肠病变的声像图表现。方法：应用经直肠腔内超声对486例肛肠病变进行研究，其中肛管直肠周围囊肿15例，脓肿283例，肛瘘165例，直肠癌23例；所有病例均行手术治疗，并获病理证实。结果：直肠腔内超声对肛管直肠周围囊肿诊断正确率为100％（15／15），脓肿诊断正常率为98％（277／283），对病变范围的诊断正确率：囊肿为90％（12／15），脓肿为73％（209／283）。对肛瘘的诊断正确率为52％（87／165）。对直肠癌的诊断正确率为82％（19／23）。结论：直肠超声对囊肿、脓肿诊断有很高的准确性，但对脓肿范围的确定存在一定误差。对肛瘘的诊断准确性相对较低。对性病肉芽肿与直肠癌早期的鉴别诊断有待提高，直肠超声诊断肛肠病变对指导临床治疗与随诊有重要价值。     

Infection of a malignant appendiceal mucocele masquerading as an appendiceal abscess: Role of preoperative sonography and CT

We report the case of a 71‐year‐old lady with a suspected appendiceal abscess in whom preoperative sonography and CT demonstrated an infected appendiceal mucocele. The lesion was surgically removed and final pathologic examination revealed malignancy. Correct recognition of the mucocele prevented a potentially disastrous percutaneous drainage. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

Mucinous appendiceal neoplasm: A case report

BACKGROUNDPrimary appendiceal tumors are histologically diverse and have an insidious onset and few specific clinical manifestations. In the majority of cases, these tumors are discovered after appendectomy during pathological exam of the resected tissue. Treatment may include appendectomy (simple or radical) and right hemicolectomy depending on factors such as histological type, tumor size and lymph node/organ involvement. The aim of this case study is to describe a rare case of a giant appendicular mucocele and raise awareness of this condition and its management options and follow-up protocol.CASE SUMMARYWe present the case of a 43-year-old patient who presented to our emergency department with mild right lower quadrant pain. After the initial check-up and imaging exams, he underwent surgery, where a giant 20 cm × 13 cm appendicular tumor was found and resected. Appendicular mucocele was suspected due to the macroscopic appearance and was later confirmed by the pathological exam. The patient’s postoperative evolution was uneventful, and after discharge, he was included in our follow-up program.CONCLUSIONIn conclusion, mucinous appendiceal neoplasms embody a rare pathology; they are asymptomatic or have few, unspecific clinical signs and in many cases are discovered after appendectomy.     

阑尾黏液囊肿的CT影像诊断特点及临床分析

目的:分析阑尾黏液囊肿的CT影像诊断特点,提高该病诊断及鉴别诊断水平。方法:回顾性分析经手术病理证实的阑尾黏液囊肿患者12例,分析阑尾黏液囊肿的CT特点及注意事项进行分析。结果:CT扫描显示,5例患者右下腹可见低密度肿块,与盲肠关系密切;7例表现为位于右下腹的边缘光滑的囊性肿块,囊壁较薄,呈卵圆形或哑铃形,囊肿大小不一,直径2~10cm,平均直径(4.7±1.5)cm,囊内容物CT扫描值为8~18Hu;2例囊壁可见不同程度钙化;1例边缘不清,四周渗出,肠系膜脂肪间隙密度变高;5例进行增强扫描,2例无增强,3例囊壁轻度环形增强现象,囊内容物无明显增强现象。12例手术病理诊断为单纯黏液囊肿9例,阑尾黏液性囊腺瘤2例,黏液性囊腺癌1例。结论:阑尾黏液囊肿无特异性临床表现,其CT表现具有一定特征性,典型征象显示右下腹薄壁囊性肿块伴囊壁弧形钙化及盲肠受压,增强扫描显示囊壁呈轻度环行均一强化,囊内无强化,对术前诊断和良恶性的评估具有一定诊断价值。     

Intussusception secondary to a giant appendical mucocele: preoperative diagnosis by multi-slice computed tomography

We describe a rare case of a giant appendiceal mucocele as the leading point with ileocolic intussusception and the cause of acute right lower quadrant abdominal pain in an adult patient, which is correctly diagnosed by computed tomography (CT) imaging before surgery.     

64排螺旋CT对阑尾黏液囊肿的CT诊断及其临床价值

目的：探讨64排螺旋CT在阑尾黏液囊肿诊断中的特征及临床价值.材料与方法：回顾性分析我院收治的14例阑尾黏液囊肿患者的临床资料,并对其64排螺旋CT诊断状况进行总结和分析.结果：14例患者的病灶呈大小不等的囊性肿块,9例呈类圆形、长管状,3例呈分叶状,2例呈“逗号”状,病灶部位处于右下腹近回盲部或右侧盆腔内.所有病灶都未发现分隔,内容物CT值为10～30 HU.8例增强扫描者中,2例囊壁未见强化,6例轻度强化.11例病灶附近结构清晰,其中2例与盲肠分解模糊,3例合并肠套叠突入盲肠内.结论：64层排螺旋CT临床诊断阑尾黏液囊肿的影像学具有明显特异性,可作为术前明确诊断的重要参考.